Provider Demographics
NPI:1417962341
Name:GIANT EAGLE, INC.
Entity Type:Organization
Organization Name:GIANT EAGLE, INC.
Other - Org Name:GIANT EAGLE PHARMACY #0085
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE CONTRACTING & CREDENTIALI
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-967-4775
Mailing Address - Street 1:101 KAPPA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:541 ALLEGHENY BLVD
Practice Address - Street 2:SUGARCREEK TOWNE CENTER
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-2919
Practice Address - Country:US
Practice Address - Phone:814-432-2024
Practice Address - Fax:814-437-6760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3969372OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA1007764670031Medicaid
PA870021414OtherMEDICARE RAILROAD FLU
PA117931Medicare PIN
PA1007764670031Medicaid